Production of nitric oxide during surgery involving cardiopulmonary bypass.
OBJECTIVE
Surgery involving cardiopulmonary bypass induces an inflammatory response due to the contact of blood with the extracorporeal circuit. In some patients, this inflammatory response leads to multiple organ failure and death. Inflammatory states may increase the production of nitric oxide, either by increasing the activity of constitutive enzyme systems or by inducing of inflammation-specific systems. We hypothesized that surgery involving cardiopulmonary bypass would increase the production of nitric oxide in association with the inflammatory response.


METHODS
Prospective, single center, observational study.


METHODS
University-affiliated, tertiary referral cardiothoracic center.


METHODS
Eleven adult patients undergoing routine myocardial revascularization.


METHODS
Surgery for myocardial revascularization.


RESULTS
Observations were made after induction of anesthesia, before bypass, after completion of the bypass, and on return to the recovery area. Parameters measured included hemodynamics, exhaled nitric oxide concentrations, plasma nitrate/nitrite concentration, plasma and bronchoalveolar lavage myeloperoxidase concentrations, and protein carbonyl conversion. All patients survived surgery. Oxygenation index fell significantly after bypass. Plasma myeloperoxidase increased significantly during the study period. Plasma carbonyl conversion also increased, although not significantly. Plasma nitrate/nitrite and airway nitric oxide concentrations did not change through the course of the study.


CONCLUSIONS
Surgery involving cardiopulmonary bypass induced a demonstrable inflammatory response, but this response was not associated with increased nitric oxide production.
Brett
S J
SJ
Department of Critical Care, National Heart & Lung Institute, Royal Brompton Hospital, London, UK.
Quinlan
G J
GJ
Mitchell
J
J
Pepper
J R
JR
Evans
T W
TW
D000368:Aged; D001944:Breath Tests / Q000379:methods; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D002315:Cardiopulmonary Bypass / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D018375:Neutrophil Activation; D009569:Nitric Oxide / Q000032:analysis / Q000096:biosynthesis*; D011183:Postoperative Complications / Q000378:metabolism / Q000503:physiopathology; D011446:Prospective Studies
D009569:Nitric Oxide